Importance of Additional Microvascular Anastomosis in Esophageal Reconstruction after Salvage Esophagectomy

Abstract

Esophageal reconstruction after salvage esophagectomy in patients who have undergone curative-intent chemoradiotherapy for esophageal cancer is associated with a significant risk of perioperative morbidity and mortality. In particular, anastomotic leakage can cause severe and potentially fatal complications, including mediastinitis and pneumonia. The authors performed esophageal reconstruction with a pedicled right colon graft after salvage esophagectomy in eight patients. To decrease the rate of anastomotic leakage, the authors performed an additional microvascular anastomosis at the distal end of the graft. The distal stumps of the ileocolic artery and vein were anastomosed to the cervical vessels. After surgery, aspiration pneumonia and localized wound infection were observed in two patients each, but slight anastomotic leakage was observed in only one patient. Postoperative swallowing function was satisfactory in all patients. Although the incidence of anastomotic leakage is reportedly high, the authors observed anastomotic leakage in only one of eight patients. The authors believe that additional microvascular anastomosis helps prevent anastomotic leakage, especially in patients who have undergone salvage esophagectomy after curative chemoradiotherapy.

Extended left colon interposition for pharyngoesophageal reconstruction using distal‐end arterial enhancement

“…10,12,15,16 With the advent of microsurgical techniques, supercharge or vascular augmentation using an operating microscope has become reliable. 10,17 In the small series presented here, radical resection in the pharyngoesophageal region results in a long digestive defect. All defects required an extended-long conduit for reconstruction, and the gastric tube was found inadequately long to bridge the gap.…”

Esophagus reconstruction with free jejunal transfer

“…We can overcome this problem if a microvascular anastomosis is done at the distal end of the donor organ. 5 In properly selected cases, if a thoracic esophagectomy is not necessary, a free jejunal graft is used. During the procedure, a free jejunal graft with microvascular anastomosis achieves reconstruction of the cervical gastrointestinal tract.…”

Superdrainage of the ileocolic vein to the internal jugular vein interposed by an inferior mesenteric vein graft in replacing the esophagus with the right hemicolon

“…4,5 To improve the blood circulation in the intestinal conduits, vascular reconstructions of the ligated arteries (supercharge) and veins (superdrainage) of the upper parts of these conduits have been performed. 3,[6][7][8] We introduced microvascular surgical techniques for supercharge and superdrainage as early as 2004, to replace the esophagus with intestinal conduits after a subtotal esophagectomy for esophageal cancer. In our experience, the arterial circulation in these intestinal conduits brought up to the neck were suffi cient without the use of supercharge in most cases.…”